【作者】 李欣；

【导师】 范惠珍；

【作者基本信息】 南昌大学 ， 内科学（消化内科）（专业学位）， 2018， 硕士

【摘要】 背景和目的:直肠癌是全球重大的健康问题之一,发病率居高不下。随着现代影像学技术的进展,临床上确诊直肠癌已经不是难题。但是,术前的准确分期对于临床医生仍有一定难度。直肠癌的预后与肿瘤浸润的深度、淋巴结转移的个数、肿瘤大小、环周切缘、肠壁外血管侵犯等多种因素相关。患者的治疗策略由术前不同的分期决定,不同的分期也提示着患者不同的预后。因此,术前对于直肠癌准确的分期在直肠癌的诊疗过程中占据重要的地位。超声内镜(Endoscopic ultrasound,EUS)和磁共振(Magnetic Resonance Imaging,MRI)是目前简单、有效的术前分期检查项目,多项研究表明,对于判断直肠癌的肿瘤浸润深度及淋巴结转移个数(Depth of penetration and Number of lymph nodes evaluated and number positive,TN),它们拥有较好的准确度。为探讨超声内镜对比磁共振对于直肠癌术前TN分期的诊断价值,我们进行了回顾性分析。方法:回顾性分析2015年7月-2017年12月就诊于宜春市人民医院的直肠癌患者,术前均行EUS及MRI,最后经手术治疗及病理检查诊断为直肠癌。使用SPSS24.0将EUS术前TN分期准确度与MRI进行对比,同时与病理分期进行一致性比较,分析其对直肠癌TN分期的诊断效能。结果:研究总共纳入直肠癌患者42人,男性26名,女性16名,年龄在57±10.8岁。EUS对于T分期的总体准确度为78.5%(33/42),评估T1、T2、T3、T4准确度分别为100%(1/1)、62.5%(5/8)、89.7%(26/29)、25%(1/4);MRI对于T分期的总体准确度为85.71%(36/42),评估T1、T2、T3、T4准确度分别为0(0/1)、75%(6/8)、93.1%(27/29)、75%(3/4)。EUS对于T1、T2、T3、T4的灵敏度和特异度分别为100%和100%、62.5%和100%、89.7%和53.8%、25%和92.1%。MRI对于T1、T2、T3、T4的灵敏度和特异度分别为0%和100%、75%和94.1%、93.1%和76.9%、75%和97.3%。由于T1、T2、T4期样本量少,因此T1、T2、T4准确度的可信度欠佳,故仅做描述性分析。对于T3期,EUS和MRI联合灵敏度为99%,联合特异度为41.4%。经χ~2检验,EUS对比MRI对于T3期的准确度差异无统计学意义(P=0.429>0.05)。经配对χ~2检验及kappa检验分析,EUS中T3期准确度与术后病理分期差异无统计学意义(P=0.508>0.05),与术后分期的一致性较好(kappa=0.465,P=0.005<0.05)。EUS及MRI对于诊断淋巴结有无转移的准确率分别为66.67%(28/42)、85.7%(36/42)。经χ~2检验,EUS对于诊断淋巴结有无转移的准确度与MRI准确度的差异有统计学意义(P=0.04<0.05)。结论:1、EUS对于诊断T3期直肠癌准确度与MRI相似,必要时可替代MRI,为直肠癌的术前分期提供可靠的依据。2、MRI对于识别有无淋巴结转移较EUS更具有价值。更多还原

【Abstract】 Background and purpose:Rectal cancer remains one of the world’s major health problems,and the incidence remains high.With the development of imaging technology,it is not difficult to diagnose rectal cancer.But,preoperative accurate staging is still a question for further study by clinicians.The prognosis of rectal cancer is related to many factors,such as the depth of tumor infiltration,number of lymph node metastasis,tumor size,circumferential resection margin,External vascular invasion,etc.The treatment strategies of patients were determined by different stages of preoperative treatment,and different stages also indicated different prognosis of patients.Therefore,the accurate staging of preoperative rectal cancer plays an important role in the diagnosis and treatment of rectal cancer.Endoscopic Ultrasound(EUS)and Magnetic Resonance Imaging(MRI)are simple and effective diagnostic methods,and several studies have shown that they have good accuracy in the TN staging of rectal cancer.We retrospectively analyzed data to explore diagnostic value of Endoscopic Ultrasound and Magnetic Resonance Imaging in the preoperative TN staging of rectal cancer.Methods:We retrospectively analyzed the patient of the people’s Hospital of Yichun City from July,2015 to December,2017.All patients who performed EUS and MRI before surgery and pathologic diagnosis were rectal cancer after surgery.SPSS Version 24 was used to compare the accuracy of preoperative staging of EUS with MRI and the pathological stage.Results:There were 42 patients,including 26 males and 16 females.Their Age ranged from 57±10.8 years old.The overall accuracy of EUS for T stage was 78.5%(33/42),and the accuracy of T1,T2,T3 and T4 were 100%(1/1),62.5%(5/8),89.7%(26/29)and 25%(1/4).The overall accuracy of MRI in T stages were 85.71%(36/42),and the accuracy of T1,T2,T3 and T4 was 0(0/1),75%(6/8),93.1%(27/29)and 75%(3/4).The sensitivity and specificity of EUS for T1,T2,T3 and T4 were 100% and 100%,62.5% and 100%,89.7% and 53.8%,25% and 92.1% respectively.The sensitivity and specificity of MRI for T1,T2,T3 and T4 were 0% and 100%,75% and 94.1%,93.1% and 76.9%,75% and 97.3% respectively.Due to the small sample size of T1,T2 and T4,the reliability of T1,T2 and T4 accuracy was poor,So descriptive analysis was performed for them only.By chi-square test,The accuracy of T3 between EUS and MRI was of no significance(P=0.429 > 0.05).In T3 stage,The combined sensitivity of EUS and MRI was 99%,and the combined specificity was 41.4%.By matching chi-square test and Kappa test analysis,the accuracy of EUS for T3 stage which compares to the postoperative pathological stage was of no significant difference(P = 0.508>0.05),and was of good consistency with the postoperative stage(kappa = 0.465,P = 0.005 < 0.05).The accuracy of EUS and MRI in the diagnosis of lymph node metastasis was 66.67%(28/42)and 85.7%(36/42).The accuracy of diagnosis of lymph node metastasis between EUS and MRI was significant(P=0.04< 0.05).Conclusion:1.EUS is similar to MRI in the diagnosis of rectal cancer in the T3 stage.It can be used as an alternative to MRI if necessary,and provide a reliable basis for the preoperative staging of rectal cancer.2.MRI is more valuable for identifying lymph node metastasis than EUS.更多还原